Individual
KATIE ELIZABETH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1306 MAPLE STREET, FERRELL HOSPITAL FAMILY PRACTICE, ELDORADO, IL 62930-1666
(618) 273-3361
Mailing address
1306 MAPLE STREET, FERRELL HOSPITAL FAMILY PRACTICE, ELDORADO, IL 62930-1666
(618) 273-3361
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004431
IL
Other
Enumeration date
10/15/2012
Last updated
12/03/2013
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